Iodine as counter-irritant, part 2

More on the use of iodine as a counter-irritant. Follow the link for more information including a lot of case histories, I have copied the intro and a few plates, with instructions. The take-home point is that the counter-irritant must be applied AWAY from the area of local inflammation, over the next "vascular territory".

The Treatment of Surgical Inflammations by a New Method ~ 1870

Other means of counter-irritation are discussed in the book, I focus on IODINE.

An introduction to the concept can be found here:

 http://iodinehistory.blogspot.com/2012/09/iodin-as-counter-irritant-artificial.html


KEY POINT~ What are the principal conditions which are needed for the prosperous beginning and progress of an inflammation? An inflamed part must have increased space —more room for swelling, it must have more blood, it is all the better for perpetual unrest. There must be no other inflammation near to interfere with it—two inflammations do not flourish together.

In the following pages I assume (and the results recorded hereafter justify the assumption) that the- inflammatory process is one and the same process wherever it- may occur, and that the best remedies for any inflammation are the best in all. That drugs have, for certain purposes, great utility I do not deny. Putting aside, however, specific inflammations I know no drug, or combination of drugs, that can cure an inflammation. Counter-irritation can unquestionably cure inflammations. Let me cite one fact among many. An inflamed patellar bursa, before chronic thickening sets in, can be most certainly cured by a ring of blister placed around it, when every other remedy fails. Seeing that counter-irritation could do what no other remedy could, I put a ring of counter-irritation around abscesses, carbuncles, cellulitis, and other inflammations, and discovered striking and rapid results. I next sought to find out the most favourable localities for counter-irritation in every inflammation.

It appeared to me that it should always be established over the next, or another, vessel or vascular territory.

I knew that even and gentle pressure could rapidly arrest some, especially chronic, inflammations. For removing the products of inflammation I knew no remedy to be compared with it. I used it, therefore, in all accessible inflammations.

The best mode of using the best remedies (counter-irritation, pressure, rest, and a few others) in every inflammation is not a routine treatment. Take counter-irritation alone; there is endless scope for individual and independent judgment in the determination of its best localities, best degrees of intensity, best extent and configuration of area, and best modes of production. It is the same with the other remedies advocated in these pages.

One of the greatest advantages of counterirritation is this—it immediately and efficiently relieves inflammatory pain. Most patients are eager to exchange a continuous, dull, wearing, inflammatory pain for a temporary smarting.

The cases are very briefly reported, as they are intended simply to illustrate the effects of treatment.


The following diagrams are mostly drawn from actual cases. The dotted lines show the extent of counterirritation, of a moderate character, as effected by iodine pigment. Unless otherwise indicated, the whole circumference of the limb is irritated.

PLATE I.
Fig. 1.—Extent of counter-irritation in a large abscess of the fore-arm. If the first application of iodine is efficient, the relief of pain is striking and immediate. See Mr. Hodges's case of Mammary Abscess, and Mr. Turton's cases of Carbuncle.

Fig. 2.—Shows singular appearance, after twenty-four hours of counter-irritation, in removing inflammation, and circumscribing pus. I have several times seen this tumourlike collection of pus removed in a few days by continued counter-irritation.

Fig. 3.—Extent of counter-irritation (iodine) in abscess of popliteal space. An iodine paint is applied to the whole circumference of the limb within the dotted lines.

PLATE V.

Fig. 1.—Counter-irritation in carbuncle. A mild form should be more extensive, as in next fig. also.

Fig. 2.—Counter-irritation in a single boil, and in a cluster of boils.

Figs. 1 & 2.—Show extent of moderately vigorous (iodine pigment) counter-irritation in synovitis and early articular ostitis of knee and ankle.

Fig. 3.—Is intended to show use of actual cautery in severe articular ostitis of shoulder. One stripe is at the front, one at the back of the joint, and one midway between the two.

PLATE XIV.

Fig. 1.—Shows mode of using counter-irritation (acetum lyttao in severest, iodine liniment in less severe cases) in purulent inflammations, especially gonorrheal, of conjunctiva. Where counter-irritation must be repeated or kept up, two horseshoe shapes, one within the other, are useful.

Fig. 2.—Shows sharp counter-irritation in the more acute laryngeal inflammations.

Fig. 3.—A milder counter-irritation in the less acute inflammations.

iodin as counter-irritant~ "artificial hyperemia", part 1

An introduction to the concept of "artificial hyperemia" and the usefulness of iodine as a counter-irritant.

text source: Dental materia medica and therapeutics  1920

"the blood must continue to circulate—there must never be a stasis of the blood." 

blood circulation~ wiki images

...Within recent years a new remedial measure has been introduced into therapeutics for the purpose of combating infectious diseases which is so surprisingly simple, and yet so very definite in its final result, that one can only wonder why it was not discovered a long time ago. The object of the treatment consists in the increased utilization of the natural resources which the body possesses in the fight against local infection, and is known at present as the hyperemic treatment of Bier. Bier founded his conception of this treatment on observations which he had made in the clinic of Rokitansky in Vienna. He had repeatedly pointed out that a lung with a chronic obstructive hyperemia resulting from some valvular insufficiency of the heart would not, in the great majority of cases, be attacked by tuberculosis. On logical reasoning Bier applied the same principle with surprisingly good results in the treatment of chronic infections of the joints. In due time the technic of this treatment, depending largely upon the construction of suitable apparatus, had to undergo many modifications; but, even with the remarkable increase of the scope of its utilization it is still employed by comparatively few practitioners...

...the aim of Bier's hyperemic treatment is to bring about "the increase of the beneficial inflammatory hyperemia resulting from the fight of the living body against invasion," and the most important principle underlying this treatment is that "the blood must continue to circulate—there must never be a stasis of the blood." ...

...At present it is generally conceded that inflammation is not a disease, but that it is the local defense of the tissues against an injury, manifesting itself by more or less pronounced symptoms— as redness, heat, swelling, pain, and impaired function. The most important changes occur in the blood vessels, which are distended by an increased influx of blood that is very quickly displaced by a retarded afflux. The white corpuscles conglomerate in bunches near the vessel wall, especially in the veins and capillaries, while the red blood corpuscles keep more to the center of the blood stream. The leucocytes and the lymphocytes now pass between the endothelial cells through the vessel walls of the veins and of the capillaries, but not of the arteries. This wandering of the white corpuscles—diapedesis—is accompanied by the transudation of blood serum, which fills the surrounding tissues, causing an edematous swelling. Later on the red blood corpuscles follow, but they migrate in very much smaller quantities... 

Whenever living tissue is injured—whether by mechanical, thermal, or chemic means—the system at once tries to protect itself against the invading foe by an increased rush of blood into the injured area, resulting either in a victorious fight—complete resolution, or in a surrender to the enemy—necrosis.



According to the conception of the older practitioners, irritants were employed for the purpose of depleting the "malignant humors" from the diseased part into the immediate neighborhood. Such irritants were known as derivants, while revulsives were used to disseminate these humors into the farther situated parts. In many instances irritants are applied to the healthy tissue somewhat distant from the primary seat of disturbance, with the intention of diverting the deep-seated congestion into a new direction, or, as our forefathers expressed it, "to leave a way for the escape of the humors." Proof for this supposition has never been furnished. Medicaments applied for these purposes are known as counterirritants. If strong irritants are applied to a circumscribed area of tissue, an exudation of small globules of serum occurs; the latter soon coalesce and raise the epidermis of the true skin, thereby forming a blister...

...At present it is generally recognized that the milder irritants produce the preliminary stages of inflammation—hyperemia. An increased influx and a retarded afflux of blood in the irritated tissue is the sequence of the irritation, and not, as it has been generally supposed, a diversion of the blood stream. Depending on the nature of the irritant, the congestion may be superficial, or it may reach to quite a depth. Hyperemia, in the sense of Bier (see Artificial Hyperemia), is one of the most important functions which nature possesses in overcoming morbid processes. Tissues which are richly supplied with blood possess a very pronounced restorative power, and there is no doubt that artificial hyperemia exercises a distinct beneficial influence on the reparative processes. This is partially the reason why wounds in the oral cavity heal so much quicker than in other parts of the body. Pain in deepseated structures is often mitigated by applying an irritant. By counterirritation of a sensory surface located somewhat distant from the primary seat of irritation, we may be able to divert the pain to this newly excited focus. Such applications are usually employed in the many forms of ill-defined pericemental disturbances. Some of the substances employed as irritants act by reflex action—that is, after their primary action they produce socalled reflexes, which have a beneficial influence on pathologic disturbances.

It should be remembered that the same irritant produces different effects on tissues of different resistance. The more delicate mucous membrane of the mouth requires naturally less severe irritation to produce definite results than the thick and horny layers of the skin.

Counterirritation is sometimes referred to as depletion. Depletives (to empty) are means which were very frequently used in former years for the purpose of locally abstracting blood or serum from the tissues in general or from the point of disease. Dry and wet cupping, scarification, and leeching were the usual methods employed for such purposes. Local depiction by physical means is rarely practiced at present. General depletion of the system by artificially increased perspiration or by abstracting fluids from the body through the bowel by salines or hydragogues are referred to under Cathartics and Diaphoretics.

Iodin in aqueous or in alcoholic solution occupies an important place among the irritants. It possesses a powerful and penetrating action. 

iodine molecule- wiki images

Iodin; Iodum, U. S. P., B. P.; I; Iode, F.; Jod, G.

Source And Character.—Iodin (from the Greek ioeides, violet-colored) was discovered by Courtois in 1811, and named iodin by Gay-Lussac on account of its violet-colored vapors. Iodin is prepared from crude iodin, which is obtained from kelp, but principally from the mother liquors of Chile saltpeter of South America. It forms heavy, bluish-black, friable crystals, having a characteristic odor and a sharp and acrid taste. It is soluble in 5,000 parts of water, 10 parts of alcohol, freely soluble in ether, chloroform, and in the solution of the iodids of the alkalies. Its alcoholic solution has a reddish-brown color, while, when dissolved in chloroform or carbon disulphid, it exhibits a violet tint. It volatilizes at ordinary temperature and fuses at about 239° F. (115° C). It is incompatible with starch, tannin, vegetable colors, etc.

Average Dose.—1/10 grain (0.005 Gm.).

Medical Properties.—Antiseptic, caustic, and alterative.

Therapeutics.—Iodin, in concentrated solution, acts as a caustic; in diluted solution, applied locally, it produces only irritant effects. Iodin has a peculiar action on the vessel walls, as it increases their penetrability. It produces typical fibrinous inflammation of the serous membranes. After the destruction of their epithelial coat, these serous membranes show a pronounced tendency to stick together and to heal by first intention. For this reason iodin is successfully employed in the treatment of fistulous tracts, etc. Painted on the skin, iodin quickly penetrates into the structures, and produces sensible irritation, thereby relieving pain which may be present in the deep-seated tissues. Incidentally it enlarges the walls of the various vessels, promotes absorption, and by reflex action produces venous hyperemia, which involves all the tissues within the affected area. The favorable influence of this artificially produced hyperemia on the diseased tissues is more fully discussed under Physical Therapeutics. (See Artificial Hyperemia.) Iodin is very freely employed in an alcoholic solution (tincture of iodin), and as the milder acting Lugol's solution. In using the tincture of iodin the alcoholic component of the latter must be accredited with a certain share of its action.

To promote the more ready absorption of iodin, various solutions have been recently introduced. Iodipin, an iodized sesame oil, containing respectively 10 and 25 per cent of iodin, and iothion, a glycerinated solution, containing 77 per cent of iodin, are the more important representatives of this group. Both preparations are almost colorless and odorless, and are used as substitutes for the tincture for external and internal purposes.


Preparations.—

Tincture of Iodin; Tinctura Iodi, II. S. P., B. P. It contains 7 per cent (2.5 per cent, B. P.) of iodin dissolved in alcohol. The U. S. P. tincture contains in addition 5 per cent of potassium iodin, which increases its therapeutic effect and stability.
Compound Solution of Iodin; Liquor Iodi Compositus, U. S. P.; Lugol's Solution. It contains 5 per cent of iodin dissolved in a 10 per cent aqueous solution of potassium iodid.

Iodin Liniment; Liquor Iodi Fords, B. P. It contains about 14 per cent of iodin.

Therapeutics.—Tincture of iodin is universally employed as a counterirritant in pericemental disturbances. Its beneficial influence is based on three principal functions of iodin—to act as a derivant by sensory irritation, to produce artificial hyperemia, and to promote absorption. Its antiseptic properties are of less importance in this connection. If a definite iodin action is desired in the mouth, the ordinary tincture is not well suited for this purpose. Its alcoholic component causes superficial coagulation of the delicate mucous membrane, and in reality very little iodin is absorbed from this weak solution. If the tincture is repeatedly applied at short intervals, the caustic effect of the alcohol destroys the mucous lining, and a painful excoriated surface is the result. The irritating effect of the alcohol is probably as much responsible for the apparent results attributed to the tincture as its iodin component. Liquid iodin preparation for dental purposes should be concentrated solutions in water, preferably in the form of Talbot's iodo-glycerol. (See page 206.) A colorless tincture of iodin is occasionally demanded; ammonia water added to the tincture will quickly destroy its color. If higher concentrated iodin solutions are wanted, Carson's or Churchill's iodin paint is serviceable, but these compounds should not be used indiscriminately on the mucous surfaces of the mouth...